Hand and Wrist Injuries in Winter Sports

Snow and ice can be hazardous enough, but add speed to the equation, and the chance of injury increases considerably. With or without speed, most hand and wrist injuries occurring in winter sports are caused by falls. It's not surprising that we injure our hands, thumbs, fingers, and wrists because when we begin to totter or stumble, we automatically try to break the fall with our hands. Unfortunately, breaking a fall with an outstretched hand can lead to strained or torn ligaments (tissue connecting bone), fractures, and contusions.

Skier's thumb
Injury to the thumb ligament has become one of the more common skiing injuries over the past 20 years. It ranks second only to knee sprains. Skier's thumb is a strain or tear to the thumb's major stabilizing ligament-the ulnar collateral ligament of the metacarpophalangeal joint of the thumb (Fig. 1). The ulnar collateral ligament assists us in grasping, pinching, and stabilizing items in our hands. Injury to the thumb while skiing usually results from a fall on an outstretched hand that continues to hold the ski pole. At impact, the thumb is driven directly into the snow and is bent back or to the side, away from the palm and index finger, straining or tearing the ligament. When injured, the ulnar collateral ligament and other ligaments cannot support the thumb bone, making grasping or pinching with the thumb difficult.

Thumb injuries require evaluation to establish the correct diagnosis and initiate proper treatment. Physical signs include pain, swelling, and tenderness on the inner side of the metacarpophalangeal joint and loss of strength in the thumb. X-rays should be taken to rule out damage to the bone. Sometimes, a small piece of the bone is torn off with the ligament. Treatment for a torn ligament usually consists of a brief period of wearing a splint or cast for immobilization. Occasionally, however, with complete tears or displacement of the ligament, surgery is required to repair the injured ligament. Long-term problems can result from instability of the thumb. With proper treatment, however, the patient can regain full function and return to activity.

To avoid injury, skiers can use various types of safety devices that include strapless poles with a hand protection device, or an already injured thumb can be protected with gloves that have built-in splints. The best protection, however, is skiing lessons that help you learn to fall properly.

Ice-skating falls
Ice-skating injuries usually are the result of a fall, rather than a collision, and beginners are much more likely to be injured than experienced skaters. As for skiers, a lesson on how to fall will greatly decrease the risk of injury. A common injury that occurs while ice skating is a wrist fracture. The wrist is often fractured during a fall on an outstretched arm. In this position, the arm remains straight and the wrist takes the full force of the fall.

A physician should examine a person with severe wrist pain after a fall, and x-rays should be taken to rule out a fracture. While the two bones in the forearm, the radius and the ulna, are the most likely to fracture, it is also possible that the small bone in the wrist just behind the base of the thumb, the scaphoid bone, can fracture. A scaphoid fracture is difficult to find even with x-rays because the fracture line is very fine (Fig. 2). If wrist pain persists after a negative x-ray, then the wrist should be x-rayed again about 10 days after injury. By then, the healing process causes the fracture line to widen, making it more visible. If left untreated, a scaphoid fracture can lead to chronic pain in the wrist and the inability to extend the wrist backward.

Prevention is the best protection against winter injuries. Being in shape and having the proper equipment can help to reduce injuries, but learning how to fall correctly and safely can be your best bet for preventing injury.

David C. Rehak, M.D.
Columbus, Georgia

Further Reading:
Morgan WJ, Lowman LS. Acute hand and wrist injuries in athletes: evaluation and management. J Am Acad Orthop Surg. 2001;9:389-400.
American Society for Surgery of the Hand. The Hand: Primary Care of Common Problems. 2nd ed. St. Louis, MO: Harcourt:2000.